Back Pain

Back Pain Overview

Low back or spinal pain is one of the most common conditions that chiropractors treat. Back pain is a symptom, not a diagnosis. Once we diagnose the cause of your pain we can discuss what treatment methods will be best for you. The way we treat each patient will differ depending on what is the primary cause of their pain and if any risk factors are present.

The way our chiropractor treats back pain is more than just manipulation of the spine. Your treatment will generally begin with hands-on manual therapy like massage and stretching to help improve mobility and reduce pain. We also use techniques like dry needling, fascia release, joint adjustments, mobilisation or manipulation, which can also be used depending on your condition and personal treatment preferences.

Mobility and strengthening exercises are essential as part of a low back pain rehabilitation program. The programs we give our patients can be performed at home or in a gym. We try to include rehabilitation exercises as early as possible to help speed up your recovery.

chiropractor treating low back pain

The Lumbar Spine

The low back is also referred to as the lumbar spine. It’s made up of the lumbar vertebrae, intervertebral disks, facet joints, ligaments, nerves and supporting muscles. All these structures work together allowing the low back to be both strong and stable, as well as flexible and mobile at other times.

The structure of the lumbar spine is different to that of the thoracic spine (mid back) and the cervical spine (neck). Pain and injuries in this part of the spine present differently compared to other regions of the spine.

Spinal health can be a complex topic. The best course of treatment can only be recommended after an accurate diagnosis has been made. The treatment methods and techniques that we use will be based on the latest and best practices in physical and manual medicine.

Back Pain Explained

Spinal pain is generally categorised into one of two categories. They are:

Mechanical back pain

Mechanical low back pain originates from the joints, ligaments, muscles or bones in the low back. Pain may be felt in the hamstring, upper thigh, glutes or over the sacrum. This type of pain is sometimes confused with radicular pain or nerve pain (which we’ll explain in the next paragraph) due to the fact that the cause of the pain originates in the back but the site of pain is felt somewhere else lower down.

This type of pain is often exaggerated by compressing or loading the spine, moving the spine through different ranges of motion and sometimes due to prolonged sitting or standing.

Radicular back pain

Radicular pain is due to irritation or impingement of the spinal nerve root as it exits the spine and travels towards your legs. Radicular pain is often due to a bulging or herniated intervertebral disk, spondylosis (arthritic bone formation around the spinal joints) or inflammatory diseases.

Radicular pain follows a nerve root distribution, often experienced as a sharp, electric or burning pain. This type of pain is different to mechanical pain as it is often felt below the knee, down the shin, calf or into the foot. Mechanical pain is rarely felt below the knee. Not impossible, but rare.

Compression, irritation or inflammation of the spinal nerve roots can also lead to sciatica, weakness or numbness.

Causes Of Back Pain

Research has shown that around 80% of the population will suffer from low back pain during their life. Pain can arise due to irritation, inflammation or injury of the bones, ligaments, intervertebral disks, facet joints, muscles or nerves of the lumbar spine. More serious causes of low back pain arise when the spinal cord or exiting spinal nerve roots are affected due to neuroinflammatory or degenerative conditions, spinal stenosis, tumours, direct spinal trauma or intervertebral disk injuries.

Low back pain can be caused by:

  • Manual tasks or exercise that cause repetitive microtrauma to the tissues
  • Acute traumatic injuries overload and injure the structures of the low back.
  • A sedentary lifestyle can lead to disk and joint degeneration due to lack of movement, poor muscle strength and lack of spinal support.

These conditions are also known to cause low back pain:

  • Sacroiliac joint dysfunction
  • Intervertebral disk bulges or herniation
  • Degenerative disk disease
  • Facet joint sprain
  • Facet joint degeneration (spondylosis)
  • Maigne’s Syndrome
  • Piriformis syndrome

Symptoms

Symptoms will vary depending on the cause of pain. They can be severe, have a short onset duration and be extremely debilitating. Or they can have a slow, gradual onset that gets progressively worse with time.

Some common symptoms that patients report to us are:

  • Dull, aching pain on one side or across both sides of the low back.
  • Pain running horizontally from the low back into the glute or hip on the same side.
  • Muscle spasm, reduced mobility, tight hamstrings.
  • Pain or a “catching” sensation that is felt when going from sitting to standing.

Risk Factors

There are some well-known risk factors for low back pain such as repetitive sprains and strains, heavy manual occupations and contact sports. There are some lesser-known risk factors which are:

  • Smoking
  • Low physical activity
  • Corticosteroid use
  • Obesity
  • High physical or emotional stress

Acute, Sub-acute & Chronic Pain

Acute pain is pain that has been present for less than 6 weeks. It’s considered the body’s natural response to tissue injury. This type of pain can often subside as the injury heals.

Sub-acute pain is typically mechanical and lasts anywhere from six to twelve weeks.

Chronic pain is pain that has been present for over 12 weeks. It can be slow to respond to manual treatment which is why other active care strategies such as exercise diet, sleep and stress management are core components of chronic pain management.

How To Treat Back Pain

The majority of cases are acute, meaning they are present for less than 6 weeks and often resolve on their own. However, if the pain or disability is interfering with your sleep, ability to work or go about your daily tasks then that is when an accurate assessment and treatment needs to be performed.

There are many different treatment options ranging from at-home management with stretching and exercises, to manual hands-on therapy, dry needling, joint manipulation and or mobilisation with a chiropractor or physio. Surgical options vary depending on the cause and severity of your pain and might include cortisone injections, laminectomy (where part of the bone is removed to reduce pressure off the nerve), microdiscectomy or spinal fusion techniques.

How Does A Chiropractor Treat Back Pain?

Conservative, non-surgical treatment is a route that most people choose to go down first before considering surgical treatment (unless it’s a medical emergency and surgery is required ASAP).

Chiropractors have evolved over the years and have started to incorporate soft tissue, muscle and rehabilitation techniques from other professions such as physio and osteopathy. In the past chiropractors would only manipulate the spine and perform no other treatment techniques (some still practice this way today). Spinal manipulation has its benefits and is a great treatment option for the right kind of patient. Not every patient will respond to spinal manipulation. The role of the chiropractor is to determine whether a patient would benefit from spinal manipulation or another treatment option.

At Prime Health Co. we use manual chiropractic adjustments to restore normal movement of the joints in the spine. We typically combine that with other treatment methods like dry needling, massage, shockwave therapy and stretching. Your bones do not go “out of alignment”, and chiropractors don’t realign the bones in your spine. This is an old outdated way of thinking. Rehabilitation and mobility exercises are prescribed to help you continue to manage your back at home in between treatment sessions.

treatment of low back pain by a chiropractor

Why Is The Pain Worse In The Morning?

Pain can be worse in the morning due to osteoarthritic changes in the spine, intervertebral disk injuries, poor sleeping position or lack of support from your mattress. Let’s explain those in further detail

Osteoarthritis or spondylosis: Morning pain lasts for about 20-30 minutes. It’s usually worse as you wake up and gradually improves as you get moving.

Intervertebral disk bulges or herniations can sometimes be more painful in the morning due to the increase in fluid content in the intervertebral disk throughout the night. This is due to your spine being horizontal and not having to support the weight of your body, the intervertebral disk hydration increases and the disk swells. This is a completely normal process that happens daily and is often not noticed if your intervertebral disks are healthy. However, in intervertebral disks that are injured or degenerated, the normal process of disk swelling can cause an increase in morning pain.

Poor sleeping positions can cause pain in the morning if you sleep on your stomach or one leg crossed over the other. This places increased stress or tension on the joints, muscles and ligaments of the spine. Sleeping on your back or on your side with a pillow between your knees is regarded as a better sleeping position because your spine and pelvis are maintained in a neutral position throughout the night.

Lack of support from your mattress can occur as your mattress begins to age. Most mattresses last 10-15 years before they wear out and are unable to maintain your body in a neutral position throughout the night. This number can increase or decrease depending on the quality of the mattress and your body weight etc. If you’re going to bed without pain but waking up stiff or sore in the morning, this is a potential cause to consider.

What Are The Best Exercises For Back Pain?

We usually recommend that patients try to stay as active and move as much as possible even in the early stages of rehabilitation. Simple exercises such as walking or swimming are great for staying active and mobile. Although bed rest may provide short-term relief from back pain for some patients, it’s important to stay active otherwise you risk losing the strength of the muscles that support your spine.

We would then consider prescribing some of these exercises below to help strengthen the core muscles around the spine and in the hips:

  • McGill curl up
  • Side plank
  • Quadruped reach

Those three exercises are known as the McGill Big 3. They are effective at maintaining the spine in a neutral position while strengthening and increasing the endurance of the core muscles around the spine.

Depending on your goals, we would consider prescribing exercises that can be done in a gym or at home using weights or bands.

Does Stretching Help With Back Pain?

Stretching the muscles in your legs, hips and back can sometimes provide temporary relief from back pain. Just remember that a muscle may be tight as a protective mechanism to limit too much movement in your spine or legs. Occasionally this protective muscle tightness goes on for longer than we need and this is when myofascial pain can develop.

It’s important to consult with your chiro before adding stretches into your rehabilitation program as some stretches can slow down your recovery.

Dynamic stretching can be an effective way of improving range of motion of the spine without inhibiting any muscle groups. This is something that we can incorporate into your rehabilitation program.

At Home Management & Other Advice

There are some small changes that you can make to your daily lifestyle and routine to help with your recovery:

  • Dietary changes: Try and cut out as much processed food, sugar and alcohol from your diet. An anti-inflammatory diet can help reduce the severity of your pain.
  • Supplements: There are a range of natural supplements that have been developed to help mediate pain and inflammation in the body. We can recommend which supplements would suit your condition.
  • Stay active: Even if you can’t handle a 60-minute gym session, just taking regular breaks to get up and move or take a walk around the block can help tremendously.
  • Quit smoking: Smoking damages the blood vessels affecting the microcirculation in the vertebrae and nutrient delivery to the intervertebral disks of the spine.
  • Manage sleep, stress & anxiety: Our psychological state can affect the way our brains perceive and deal with pain.

Don’t Put Up With Back Pain, We Can Help